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Ruminant Medicine Exam 3 (Spring 2016) > L24: Sepsis, Failure Of Passive Transfer, And Fluid Therapy In Calves (Reuss) > Flashcards

L24: Sepsis, Failure Of Passive Transfer, And Fluid Therapy In Calves (Reuss) Flashcards

1
Q

Infection in sepsis can be:

A
  • bacteremia, viremia, fungemia, etc.
  • endotoxemia: circulating LPS
  • generalized or focal
  • identified or suspected
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2
Q

Portals of entry for sepsis

A
  • in utero
  • ingestion (via non-selective pinocytosis, translocation of enteritis; most common)
  • inhalation
  • umbilical (uncommon)
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3
Q

Risk factors for developing sepsis

A
  • failure of passive transfer
  • lack of normal adult intestinal flora
  • environmental
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4
Q

Etiology of sepsis

A
  • E. Coli (>50%)
  • Salmonella
  • Campylobacter
  • Klebsiella
  • Listeria
  • Staph/Strep
  • Lepto
  • Actinobacillus
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5
Q

Steps of sepsis

A
  1. Infection (invasion of normally sterile host tissue)
  2. Systemic inflammatory response
  3. Septic shock
  4. Multiple organ dysfx syndrome
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6
Q

CS of generalized sepsis

A
  • altered mental status
  • weakness
  • lack of suckle
  • abnormal TPR (fever or hypothermia)
  • Diarrhea
  • Acute death
  • scleral injection
  • petechiation, ecchy, hyperemia
  • cold extremities, slow CRT, weak pulses
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7
Q

Local infections assoc. with sepsis

A

(Often sequelae to generalized infection)
-usually in older calves

Septic arthritis
Meningitis
Hypopyon
Pneumonia

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8
Q

Umbilical disorders

A
  • urachus most commonly affected structure
  • can cause systemic sepsis, or walled off internal abscesses in older calves
  • abscesses can lead to fever, poor condition, dysuria, stranguria, colic +/- septic peritonitis if they rupture
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9
Q

Dx of sepsis

A 
Blood culture
Hematology:
-leukopenia due to neutropenia
-toxic neutrophils, degenerative L shift
-leukocytosis with persistent infection
-decreased (?) fibrinogen

Chemistry (hypoglycemia +/- hypoproteinemia)
Blood Gas
Misc: Thoracic rads, US, arthrocentesis, CSF aspirate

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10
Q

Explain chemistry changes in septic calf

A

Hypoglycemia (esp. In younger calves) since bacteria consuming glucose. Hypoproteinemia if failure of passive transfer.

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11
Q

Blood gas changes in septic calf

A
  • Metabolic acidosis due to L and/or D lactate
  • Hypoxemia
  • Hypoventilation
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12
Q

Metabolic acidosis: young vs. old calves

A
  • L lactate comes from calves and more common in younger calves, and D lactate comes from bacteria and more prevalent in older calves with greater bacterial flora in GIT.
  • older calves will usually have worse acidemia and may need to be treated with bicarb, whereas younger calves can be treated with crystalloid fluids
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13
Q

Tx of sepsis

A

Abx:

  • Ceftiofur = drug of choice (off label) because reaches MIC for E. Coli
  • Ampicillin
  • Florfenicol
  • anti-inflammatory (flunixin)
  • address failure of passive transfer
  • fluid support
  • nutritional support
  • supportive care
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14
Q

Duration of abx tx for sepsis

A

7-10 days if sepsis suspected but undocumented
2 wks if + blood culture but not localized
3-4 wks if localized infection

Or until have normal WBC, fibrinogen, rads

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15
Q

Supportive care of septic calf

A
  • warmth, good bedding
  • oxygen, ventilation
  • address decubital sores, urine scald, fecal scald
  • postural changes, physical therapy
  • ocular monitoring/tx
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16
Q

passive transfer

A
  • epitheliochorial placentation doesn’t transfer Abs, WBCs
  • calves are immunocompetent at birth and have protective Ab lvls at 30 days with maximal lvls at 2-3 mos.
  • passive immunity impacts long-term production
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17
Q

Properties of colostrum

A
  • secreted last 4-6 wks of pregnancy
  • IgG > IgM, IgA
  • offers local protection
  • contains fat, protein, vitamins, minerals, lactoferrin, growth factors, mis. Immune factors
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18
Q

Absorption of colostrum

A

Nonselective pinocytosis by intestinal ep. –> lymphatics –> blood

  • closure stimulated by ingestion of any material
  • capacity 50% at 6 hrs, 33% at 8 hrs, 0 at 24 hrs
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19
Q

Delivery of colostrum

A
  • 3-4 L of good quality should be delivered
  • concentration should be >1.050
  • delivered via natural sucking (60% have FPT!), bottle feeding (19% FPT), or esophageal feeder in one large volume (most successful with only 10% FPT)
20
Q

Factors that effect transfer of IgG

A
  • timing of colostral feeding
  • colostral IgG
  • dam parity
  • volume fed
  • method of administration
21
Q

When to test for passive transfer

A

At 12-24 hrs, at least one in 1st few days

  • detectable within 2 hrs of ingestion, and peaks at 32 hrs
  • FPT does NOT guarantee disease, but DOES predispose to sepsis
22
Q

Tests for FPT

A

1) Radial immunodiffusion (gold standard)
2) ELISA
3) Sodium Sulfite Turbidity Test
4) Zinc Sulfate Turbidity Test
5) Serum TP
6) Serum GGT
7) Glutaraldehyde coagulation test

23
Q

Radial immunodiffusion test for FPT

A

Gold standard

  • requires 24 hrs to perform
  • IgG >1000 = success
24
Q

Sodium Sulfite Turbidity Test for FPT

A
  • rapid, cost-effective, stall side
  • use 14/16/18% solutions and look for precipitation
  • precipitation at lower % solutions indicates higher Ab

-has fewer false positives that zinc sulfate turbidity test

25
Q

Serum total protein test for FPT

A

> 5.2 g/dl = adequate transfer if healthy
5.5 = adequate transfer if ill

*falsely increased by dehydration

26
Q

Serum GGT test for FPT

A

GGT should be >200 U/L at 24 hrs

27
Q

Glutaraldehyde coag. test for FPT

A

10% reagent coagulates with serum IgG >600

*Poor Sp/Se

28
Q

ELISA test for FPT

A
  • stall side, blood or plasma

- should be >10 mg/ml IgG

29
Q

Treatment of FPT

A

In first 12 hrs, give colostrum or colostrum replacer:
-2L replacer at 2 hrs + dose of supplement at 2-12 hrs –> successful PT

After 12 hrs, give plasma or whole blood transfusion

  • don’t transfuse from dam (won’t have good Ab)
  • not imperative to crossmatch

-Fluids, Nutritional support

30
Q

Colostrum supplement properties

A
  • comes from bovine colostrum, milk products, or serum
  • 40-60 g IgG/dose
  • can’t raise IgG above 1000 mg/dl
  • utilized when only low medium quality colostrum available
31
Q

Colostrum REPLACER properties

A
  • made from bovine serum or colostrum based products
  • contain at least 100g IgG per liter + fat, protein, vitamins, minerals
  • better than poor quality colostrum
  • less risk of Johnes transmission

*high quality maternal colostrum still gold standard!

32
Q

Goals of fluid therapy for FPT

A

Correct:

  • hypovolemia
  • hypoglycemia
  • metabolic acidosis
  • electrolyte abnormalities
33
Q

1-5% dehydration CS

A

Eyes not or slightly sunken
Skin tent 1-4 s
Membranes moist

34
Q

6-8% dehydration CS

A

Eyes slightly sunken
Skin tent 5-10s
Membranes tacky but calf still suckling

35
Q

9-10% dehydration CS

A

Eyes sunken
Skin tent 11-15s
Membranes tacky to dry
Calf depressed

36
Q

11-12% dehydration CS

A

Eyes very sunken
Skin tent 16-45s
Membranes dry
Calf can’t stand and is severely depressed

37
Q

Fluid calculation

A

Replacement + Maintenance + Ongoing losses

Replacement = % dehydration x BW
Maintenance = 75-100 mls/kg/day
38
Q

IV fluids indications

A 
More than 8% BW decrease
Severe CNS depression
Inability to stand
Not suckling >24h
Body temp
39
Q

Fluid choices for septic calf

A
  • Balanced crystalloids best (LRS, Normosol, Plasmalyte)
  • Physiologic saline will acidify them
  • Colloids: plasma, whole blood, hetastarch
  • Hypertonic saline not good for neonates b/c will throw off Na
40
Q

Fluid supplementations

A

1) Dextrose: 2.5-5% for hypoglycemia
2) Bicarb for D-lactic acidosis in older calves >8 days**
- should monitor pH, HCO3, TCO2

41
Q

Calculation for how much bicarb to give

A

BW x 0.5 x (24 - measured HCO3)

42
Q

Indications for oral fluids (vs. IV)

A
  • ambulatory
  • functional GIT

*is cost effective and can be done on the farm. Can give following IV fluids/bicarb, and in place of milk for short durations

43
Q

Types of oral electrolyte solution

A
  • depend on degree of acidosis and electrolyte abnormalities what type you give
  • most contain Na, Cl, K, glucose, glycine
  • if osmolarity is too low, won’t have enough glucose for energy
  • if osmolarity to high, will slow abomasal emptying rate
  • avoid >145 mmol Na/L (has no alkalinizing agent)
44
Q

Oral alkalinizing agents

A

1) Bicarb (curdles milk)
2) Acetate (best)
- doesn’t interfere w/ milk clotting, produces energy when metabolized, facilitates Na and water absorption in SI, and doesn’t alkalinize the abomasum

3) Proprionate
- also doesn’t interfere w/ milk clotting

45
Q

Nutritional support for septic calf

A
  • if unwilling to suckle, start tubing with 10-15% BW/24 hrs over 3-5 feedings
  • if bloated, provide parenteral nutrition
  • use cows milk/replacers

Ruminant Medicine Exam 3 (Spring 2016) (8 decks)

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